Recurrence of craniopharyngioma can be safely managed by using meticulous contemporary microsurgical techniques without additional radiotherapy. The role of surgery and adjuvant radiotherapy for craniopharyngiomas may vary in the future, depending on innovations in treatment and technology. Nevertheless, surgery can be still a major therapeutic option in the management of recurrent craniopharyngiomas.
An inebriated 86-year-old man impaled himself on a wooden earpick that penetrated through the superior orbital fissure into the prepontine cistern. The patient underwent surgery immediately by a lateral suboccipital approach, and the earpick was pulled out through the wound with control of hemorrhage from the cavernous sinus. He survived this event with no neurologic deficits apart from complete ipsilateral ophthalmoplegia and ptosis. Prompt imaging and surgical intervention allowing direct visualization of the foreign body and prevention of intracranial complications are part of proper management of this problem.
The authors report on the case of a 14-year-old boy who presented with bilateral visual impairment due to optic canal stenosis caused by hyperplasia of the bone marrow arising from anemia. The patient had hereditary hemolytic anemia with unstable hemoglobin of the Christchurch type. This congenital form of anemia caused hyperplasia of the bone marrow as well as hyperostosis of the entire calvarial bone, which in turn led to optic canal stenosis. The patient underwent surgical decompression of the optic canal, resulting in significant improvement in visual acuity. Pathological findings in the calvarial bone indicated hypertrophic bone marrow with no other specific features such as neoplastic pattern or fibrous dysplasia. With the exception of objective hearing impairment, no other significant cranial neuropathy has been detected thus far. On reviewing the published literature, this case was found to be the first in which hyperostosis due to congenital anemia resulted in symptomatic entrapment neuropathy of the optic nerve. The authors concluded that surgical decompression effectively improves visual acuity.
A 57-year-old man and a 45-year-old woman presented with cerebral abscesses. Diffusion-weighted magnetic resonance (MR) imaging and conventional MR imaging clearly showed the different stages of the course of the brain abscesses. As the abscess matured, the signal intensity of the center gradually increased to the typical high value with a low apparent diffusion coefficient (ADC) on diffusion-weighted MR imaging, and enhancement of the capsule on T 1 -weighted MR imaging with gadolinium. Healing of the abscess was revealed by the signal intensity of the center returning to isointense and an increase in ADC to the baseline. Surrounding edema showed an increase in ADC, followed by a return to the baseline. These changes probably reflect the pathological processes occurring in the abscesses.
Impalement injury is a rare type of trauma, and the management should be performed carefully. In cases with impalement injuries, the area of injury and crush might be extensive because the penetrating object itself is generally large and long. Herein, we report our experience with a rare case of cervical impalement injury caused by an iron reinforcing bar penetrating the optic canal and thereby causing brain contusion. A 32-year-old man fell while working at a construction site and sustained an injury due to an iron reinforcing bar that penetrated his right neck. On arrival at the hospital, consciousness was clear and the bar was removed by himself. The patient had lost the sight in his right eye, and cerebrospinal fluid (CSF) rhinorrhea was present. Based on the results of computed tomography (CT) of the head and neck, the bar was thought to have passed through the right mandible and the right optic canal and penetrated the frontal lobe. Surgical repair of frontal base was performed using femoral fascia, completely stopping the CSF leak. The patient was discharged on the 31st hospital day walking independently. In our present case, the top of a foreign body was reached an intracranial site. Impalement injuries require detailed assessment of the injury sites because outcomes depend on the severity of injuries at surrounding anatomical structures. Multiple planar reconstruction using recent multidetector row CT scanning was considered to be useful for the assessment of penetrating routes and injury severity.
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